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Pediatric Diabetes ; 23(Supplement 31):52, 2022.
Article in English | EMBASE | ID: covidwho-2137192


Introduction: COVID-19 imposed constraints on in-person medical care, challenging pediatric diabetes care. Patients and healthcare providers (HCP) can benefit from telehealth virtual visits at this time. Objective(s): Assess the access to and utilization of technology as it relates to videoconferencing and telehealth services. Assess patient and HCP satisfaction with the current virtual care services offered. Method(s): A survey was sent to patients, primary caregivers, and HCP at the clinic. Questions related to technology access, usage, and satisfaction with virtual care. Interviews were then conducted with HCP. The baseline characteristics were summarized descriptive results relating to technology access and usage were included, along with mean and median satisfaction scores. Answers to the open-ended questions and interviews were transcribed and analyzed using theme analysis. Result(s): Response rate was highest among patients with HbA1C of 7- 7.9% and lowest with HbA1C > 10%. Access to appropriate technology was high, patient and HCP satisfaction with virtual care was high. Patients preferred virtual education focused visits and in-person clinical visits. Benefits to virtual care include convenience, efficiency, money saving and challenges include lack of physical exam, excess coordination, lack of personal connection, technology issues, increased administrative burden on the HCP and a decrease in interprofessional collaboration. HCP prefer to continue with virtual care with 30%-80% of their practice. Conclusion(s): Virtual care appointments were satisfactory with few technology concerns. Participants in study were high income, high education, and spoke English. Suggestions to improve virtual care from the HCP and patient perspective were provided to include a technology support team, appointment reminders, notification for delayed appointments & better organization of blood requisitions. Further evaluation required assessing clinical outcomes of virtual care, needs of patients with language barriers, low-income & higher HbA1C.

Samj South African Medical Journal ; 112(3):240-244, 2022.
Article in English | Web of Science | ID: covidwho-1761104


Y Background. South Africa (SA) has embarked on a process to implement universal health coverage (UHC) funded by National Health Insurance (NHI). The 2019 NHI Bill proposes creation of a health technology assessment (HTA) body to inform decisions about which interventions NHI funds will cover under UHC. In practice, HTA often relies mainly on economic evaluations of cost-effectiveness and budget impact, with less attention to the systematic, specific consideration of important social, organisational and ethical impacts of the health technology in question. In this context, the South African Values and Ethics for Universal Health Coverage (SAVE-UHC) research project recognised an opportunity to help shape the health priority-setting process by providing a way to take account of multiple, ethically relevant considerations that reflect SA values. The SAVE-UHC Research Team developed and tested an SA-specific Ethics Framework for HTA assessment and analysis. Objectives. To develop and test an Ethics Framework for use in the SA context for health priority-setting. Methods. The Framework was developed iteratively by the authors and a multidisciplinary panel (18 participants) over a period of 18 months, using the principles outlined in the 2015 NHI White Paper as a starting point. The provisional Ethics Framework was then tested with multi-stakeholder simulated appraisal committees (SACs) in three provinces. The membership of each SAC roughly reflected the composition of a potential SA HTA committee. The deliberations and dedicated focus group discussions after each SAC meeting were recorded, analysed and used to refine the Framework, which was presented to the Working Group for review, comment and final approval. Results. This article describes the 12 domains of the Framework. The first four (Burden of the Health Condition, Expected Health Benefits and Harms, Cost-Effectiveness Analysis, and Budget Impact) are commonly used in HTA assessments, and a further eight cover the other ethical domains. These are Equity, Respect and Dignity, Impacts on Personal Financial Situation, Forming and Maintaining Important Personal Relationships, Ease of Suffering, Impact on Safety and Security, Solidarity and Social Cohesion, and Systems Factors and Constraints. In each domain are questions and prompts to enable use of the Framework by both analysts and assessors. Issues that arose, such as weighting of the domains and the availability of SA evidence, were discussed by the SACs. Conclusions. The Ethics Framework is intended for use in priority-setting within an HTA process. The Framework was well accepted by a diverse group of stakeholders. The final version will be a useful tool not only for HTA and other priority-setting processes in SA, but also for future efforts to create HTA methods in SA and elsewhere.